Annals of Surgical Oncology

, Volume 24, Issue 2, pp 478–485 | Cite as

Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer

  • Yutaka Yonemura
  • Haruaki Ishibashi
  • Masamitu Hirano
  • Akiyoshi Mizumoto
  • Kazuyosi Takeshita
  • Kousuke Noguchi
  • Nobuyuki Takao
  • Masumi Ichinose
  • Yang Liu
  • Yan Li
Gastrointestinal Oncology

Abstract

Background

The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70 % of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated.

Materials and Methods

In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied.

Results

In group A, the PCI score at the time of the second session (11.8 ± 11.0) was significantly lower than at the time of the first session (14.2 ± 10.7), while in group B, the PCI at the time of laparotomy (9.9 ± 11.3) was significantly lower than at the time of NLHIPEC (14.8 ± 11.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6 %) patients.

Conclusions

NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.

Supplementary material

10434_2016_5487_MOESM1_ESM.eps (603 kb)
Fig. 1 Treatment schedule of NLHIPEC and NIPS. PCI count, cytological status, and ascites volume at NLHIPEC were compared with those at laparotomy. * i.p. docetaxel + CDDP: i.p. administration of docetaxel (30 mg/m2) and CDDP (30 mg/m2) with 500 ml of saline; # i.v. docetaxel + CDDP: i.v. administration of docetaxel (30 mg/m2) and CDDP (30 mg/m2). NLHIPEC neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion, NIPS neoadjuvant intraperitoneal/systemic chemotherapy, PCI Peritoneal Cancer Index, i.p. intraperitoneal, i.v. intravenous, CDDP cisplatin (EPS 603 kb)
10434_2016_5487_MOESM2_ESM.eps (461 kb)
Fig. 2 Survival curves of patients who received NLHIPEC plus NIPS. Patients with a PCI score ≤11 (N = 35) at the time of CRS survived significantly longer than those with a PCI score ≥12 (N = 17) [Chi-square 5.93; p = 0.015]. NLHIPEC neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion, NIPS neoadjuvant intraperitoneal/systemic chemotherapy, PCI Peritoneal Cancer Index, CRS cytoreductive surgery (EPS 460 kb)
10434_2016_5487_MOESM3_ESM.docx (11 kb)
Supplementary material 3 (DOCX 11 kb)

References

  1. 1.
    Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Fontaumard E, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88:358–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Glehen O, Schreiber V, Cotte E, Sayag-Beaujard AC, Osinsky D, Freyer G, et al. Cytoreductive surgery and intraperitoneal chemohyerthermia for peritoneal carcinomatosis arising from gastric cancer. Arch Surg. 2004;139:20–26.CrossRefPubMedGoogle Scholar
  3. 3.
    Yonemura Y, Kawamura T, Bandou E, Takahashi S, Sawa T, Matsuki N. Treatment of peritoneal dissemination from gastric cancer by peritonectomy and chemohyperthermic peritoneal perfusion. Br J Surg. 2005;92(3):370–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Canbay E, Yonemura Y. Management of special issues. In: Canbay E, Yonemura Y, editors. Peritoneal surface malignancies: a curative approach. Springer; 2015. pp. 57–80.Google Scholar
  5. 5.
    Coccolini F, Catena F, Glehen O, Yonemura Y, Sugarbaker PH, Piso P, et al. Complete versus incomplete cytoreduction in peritoneal carcinosis from gastric cancer, with consideration to PCI cut-off. Systemic review and meta-analysis. Eur J Surg Oncol. 2015;41(7):911–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Yonemura Y, Elnemr A, Endou Y, Hirano M, Mizumoto A, Takao N, et al. Multidisciplinary therapy for treatment of peritoneal carcinomatosis from gastric cancer. World J Gastrointest Oncol. 2010;2:85–97.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Glehen O, Gilly FN, Arvieux C, Cotte E, Boutitie F, Mansvelt B, et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010;17(9):2370–2377.CrossRefPubMedGoogle Scholar
  8. 8.
    Valle M, Federici O, Garofalo A. Patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, and role of laparoscopy in diagnosis, staging and treatment. Surg Oncol Clin N Am. 2012;2(4):515–531.CrossRefGoogle Scholar
  9. 9.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–374.CrossRefPubMedGoogle Scholar
  10. 10.
    Dindo D, Demartines N, Clavien PA. Classification of surgical compliations. A new proposal with evaluation in cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Valle M, Van der Speeten K, Garofalo A. Laparoscopic hyperthermic intraperitoneal preoperative chemotherapy (HIPEC) in the management of refractory malignant ascites: a multi-institutional retrospective analysis in 52 patients. J Surg Oncol. 2009;100:331–334.CrossRefPubMedGoogle Scholar
  12. 12.
    Yonemura Y, Elnemr A, Endou Y, Ishibashi H, Mizumoto A, Miura M, et al. Surgical results of patients with peritoneal carcinomatosis treated with cytoreductive surgery using a new technique named aqua dissection. Gastroenterol Res Pract. 2012;2012:521487.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Hong SH, Shin YR, Roh Y, Jeong EK, Song KY, Park CH, et al. Treatment outcomes of systemic chemotherapy for peritoneal carcinomatosis arising from gastric cancer with no measurable disease: retrospective analysis from a single center. Gastric Cancer. 2013;16:290–300.CrossRefPubMedGoogle Scholar
  14. 14.
    de Bree E, Tsiftsis DD. Experimental and pharmacologic studies in intraperitoneal chemotherapy from laboratory bench to bedside. In: Gonzalez-Moleno S editor. Advances in peritoneal surface oncology. Springer; 2007. pp. 53–73.Google Scholar
  15. 15.
    Yonemura Y, Endou Y, Shinbo M, Sasaki T, Hirano M, Mizumoto A, et al. Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: selection for cytoreductive surgery. J Surg Oncol. 2009;15:311–316.CrossRefGoogle Scholar
  16. 16.
    Ishigami H, Kitayama J, Kaisaki S, Hidemura A, Kato M, Otani K, et al. Phase II study of weekly intravenous and intraperitoneal paclitaxel (PTX) combined with S-1 for advanced gastric cancer with peritoneal metastasis. Ann Oncol. 2010;21:67–70.CrossRefPubMedGoogle Scholar
  17. 17.
    Thomas F, Ferron G, Gesson-Paute A, Hristova M, Lochon I, Chatelut E. Increased tissue diffusion of oxaliplatin during laparoscopically assisted versus open heated intraoperative intraperitoneal chemotherapy. Ann Surg Oncol. 2008;15:3623–3624.CrossRefPubMedGoogle Scholar
  18. 18.
    Yonemura Y, Canbay E, Endou Y, Ishibashi H, Mizumoto A, Miura M, et al. Peritoneal cancer treatment. Expert Opin Pharmacother. 2014;15:623–636.CrossRefPubMedGoogle Scholar
  19. 19.
    Levine EA, Stewart JH, Russel GB, Geisinger KR, Loggie BL, Shen P. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg. 2007;204(5):943–53; discussion 953–5.Google Scholar
  20. 20.
    Yan TD, Links M, Fransi S, Jacques T, Black D, Saunders V, et al. Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy: a journey to becoming a Nationally Funded Peritonectomy Center. Ann Surg Oncol. 2007;14(8):2270–80.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Yutaka Yonemura
    • 1
    • 2
    • 3
    • 4
  • Haruaki Ishibashi
    • 3
  • Masamitu Hirano
    • 4
  • Akiyoshi Mizumoto
    • 4
  • Kazuyosi Takeshita
    • 3
  • Kousuke Noguchi
    • 4
  • Nobuyuki Takao
    • 4
  • Masumi Ichinose
    • 4
  • Yang Liu
    • 1
    • 3
  • Yan Li
    • 5
  1. 1.NPO Organization to Support Peritoneal Surface Malignancy TreatmentOsakaJapan
  2. 2.Department of Regional Cancer Therapies, Surface Malignancy CenterKishiwada Tokushukai Hospital, Kusatsu General HospitalKishiwadaJapan
  3. 3.Peritoneal Surface Malignancy CenterKishiwada Tokushukai HospitalKishiwadaJapan
  4. 4.Peritoneal Dissemination CenterKusatsu General HospitalKusatsuJapan
  5. 5.Department of Peritoneal Surface OncologyBeijing Shijitan Hospital of Capital Medical UniversityBeijingChina

Personalised recommendations